Carbohydrate loading: It is now recognized that adequate dietary carbohydrate in the days and hours before strenuous training and competition is critical to maintaining adequate glycogen levels in the muscles. Increasing consumption of carbohydrates in liquid or food form normally three days prior to an endurance-type event is therefore a way to enhance performance. Endurance athletes, such as marathon runners, rely on their stores of glycogen as a source of energy during competition and carbohydrate loading is a method for boosting the amount of glycogen in the body before a competition

Proper nutrition: Proper nutrition means selecting good food choices and diets that lead to maintaining health while also reducing major risk factors for diseases. The estimated average daily calorie requirement is 1940 calories per day for women and 2550 for men. If the level of activity is increased, high performance can be achieved by increasing the calorie intake according on a sound nutrition basis

Electrolyte solutions: The body requires a certain amount of fluid intake on a daily basis to function and the minimum is about equal to four 8-ounce glasses (one liter or one quart). Strenuous activity and excessive sweating call for two to three times this basic amount. It has been shown that a fluid loss equivalent to 2% of body weight can impair performance and lead to heat exhaustion at 5%. Electrolyte solutions not only provide fluid, but also contain electrolytes, the salts and minerals required for various functions by the body and that are also lost by sweating

Stress management: The increased stress of competitive sports can affect athletes both physically and mentally such that their performance abilities are lowered. Stress may lead to excessive tension, increased heart rates, cold sweats, and anxiety about the outcome of the competition. Stress management techniques are recognized ergogenic aids that help maintain concentration, confidence, control and commitment. Relaxation techniques: Relaxation is especially important for high performance athletic activities. It promotes rest, recovery and recuperation while removing stress related reactions, such as increased muscular tension. In addition, relaxation contributes to the maintenance of positive physical and mental states

Some ergogenic aids are known to have harmful side effects and this is the reason why they are banned by sports governing authorities because they are unsafe and unethical. The most abused aids include the following:

Anabolic steroids: These are synthetic hormones used to increase muscle mass and strength. They also produce a “steroid rush”, a state of euphoria and decreased fatigue that allows the athlete to train harder and longer. Many adverse effects have been documented from using these steroids

Blood doping: This is another dangerous ergogenic aid. It involves taking blood or blood products such as erythropoietin (EPO), a hormone that stimulates the bones to make red blood cells, to an athlete to improve endurance and speed. It can also have harmful side effects

Human growth hormone (HGH): HGH is a widely abused ergogenic aid by body builders. Some body builders take large doses to decrease fat and increase muscle mass. Many adverse effects have been documented

Caffeine: Caffeine affects the central nervous system by increasing mental alertness and lowering fatigue. Excessive use however, can cause irritability, restlessness, diarrhea, insomnia, and anxiety. It is found in coffee, tea, chocolate, and soft drinks

Ephedrine: Some athletes use ephedrine-containing supplements to improve their performance, have more energy or decrease their body fat. Unfortunately, athletes who use ephedrine may find that it helps them run farther and faster, but research findings have shown that it also puts them at risk of potentially life-threatening side effects. This is why the National Football League, the National Collegiate Athletic Association and the International Olympic Committee have all taken steps to keep it off the playing fields

Athletes who train hard frequently complain about energy drain and fatigue. Because they are regularly reminded to consume adequate fluids and fuel to minimize early fatigue and to maximize performance and recovery, many have turned to “energy” drinks”. These are liquid food products that contain both fluid and energy together in one bottle. Recent research sponsored by the Food and Nutrition Information Center of the United States Department of Agriculture (USDA) has shown however, that some energy drinks were found to contain herbs, amino acids, protein, and other substances in such small amounts that they were unlikely to have any noticeable effect on performance. Other energy drinks were found to have contents that may result in inefficient absorption of fluid and nutrients from the intestine, with the possibility of gastrointestinal distress. The absorption of nutrients involves a delicate balance of interactions among various nutrients and the body and boosting intake of one may upset that balance

Athletes are always looking for sound, effective aids to boost performance and many believe that herbs can improve athletic performance. Herbs are non-woody plants or parts of plants that have a long history of medicinal or therapeutic use. In fact, many common medications, such as aspirin and quinine, were first developed from herb extracts. However, if herbs can act as drugs, they are also associated with potential adverse effects or interactions with foods, other herbs, or medications.

Treatment for excessive use of ergogenic supplements starts with complete avoidance. Depending on the supplement used and the medical complications, aftercare is tailored to individual cases and depend on the nature of the resulting medical condition.

Harmful effects have been reported for several ergogenic products. Anabolic steroids have many adverse effects, most related to the unwanted andro-genic effects, such as shrinking testicles, enlarged prostate gland, and lower sperm levels. Some of the adverse effects are potentially serious and irreversible and they include heart, liver, and immune system problems. Behavior changes may include aggression, paranoia, mood swings, low sex drive, and depression. Blood doping has been linked to strokes, allergic reactions, and infections. HGH adverse effects include heart and nerve diseases, glucose intolerance, and higher levels of blood fats Other effects also come from the extra HGH levels in the body along with what is already produced by the pituitary glands. Ergogenic doses of caffeine may cause restlessness, nervousness, insomnia, and tremors. At least 17 deaths have been linked to products that combine caffeine and ephedrine. Additional risky supplements in the ephedrine class include androstenedione and other “prohormone” precursors to testosterone, yohimbine, and products that contain kava. Adverse effects have also been reported with carbohydrate supplementation. Increased insulin levels after carbohydrate consumption were shown to significantly decrease blood glucose levels in some athletes, and fructose-containing solutions have been associated with adverse gastrointestinal effects in some studies.

Parents should educate their teenagers concerning the use of ergogenic aids, and strive to increase their awareness of illegal ones. Most teens however, seem very smart in that they stay away from steroids. As part of a 2002 study funded by the National Institute for Drug Abuse, teens were asked if they had ever tried steroids, even if only once. Results were that only 2.5% of 8th graders had ever tried steroids, only 3.5% of 10th graders, and 4% of 12th graders. For teenagers, hormone balance is especially important since they are at the age of puberty. Hormones are involved in the development of feminine traits in girls and masculine traits in boys. When teenagers use steroids, there is a risk of gender mix-ups. Boys can experience shrunken testicles and can also end up with breasts (gynecomastia). Using steroids, girls can develop deeper voices and grow excessive body hair with a decrease of breast size

Steroid users may be very pleased when they flex muscle in a mirror, but they may develop health problems that may hurt them for the rest of their lives, and even shorten their lives. Ergogenic supplements, unlike medicines and other drugs, do not undergo rigorous testing and screening for efficacy and safety, but information is still available, for instance from health care providers and sport medicine practitioners or at Supplement Watch (www.supplementwatch.com) and Consumer Lab (www.consumerlab.com), which provide independent test results and information to help people evaluate and select supplements.

KEY TERMS

Amphetamines—Stimulant drugs whose effects are very similar to cocaine

Anabolic—Pertaining to the putting together of complex substances from simples ones, especially to the building of muscle protein from amino acids

Anabolic steroid—A group of synthetic hormones that promote the storage of protein and the growth of tissue, sometimes used by athletes to increase muscle size and strength

ATP—Adenosine triphosphate, a high-energy phosphate molecule required to provide energy for cellular function. The energy source of muscles for short bursts of power

Blood doping—Practice of illicitly boosting the number of red blood cells in the circulation in order to enhance athletic performance

Calorie—A unit of food energy. In nutrition terms, the word calorie is used instead of the scientific term kilocalorie which represents the amount of energy required to raise the temperature of one liter of water by one degree centigrade at sea level. In nutrition, a calorie of food energy refers to a kilocalorie and is therefore equal to 1000 true calories of energy

Carbohydrate loading—Increase consumption of carbohydrates in liquid or food form normally three days prior to an endurance type event

Central nervous system (CNS)—The central nervous system (CNS) is composed of the brain and spinal cord. The brain receives sensory information from the nerves that pass through the spinal cord, as well as other nerves such as those from sensory organs involved in sight and smell. Once received, the brain processes the sensory signals and initiates responses

Ephedrine—Central nervous system stimulant that that increases serum levels of norepinephrine. The herbs ma huang, ephedra sinica and sida cordifolia contain ephedrine, which structurally is similar to amphetamines

Erythropoietin (EPO)—Hormone secreted by the kidneys which stimulates the bones to make red blood cells (erythrocytes)

Hormone—A chemical substance produced in the body that controls and regulates the activity of certain cells or organs

Human growth hormone (HGH)—A hormone produced in the pituitary gland that stimulates growth of bone and muscle

Norepinephrine—Hormone released by the sympathetic nervous system onto the heart, blood vessels, and other organs, and by the adrenal gland into the bloodstream as part of the fight-or-flight response

Steroid—Naturally occurring or synthetic fat-soluble organic compounds having as a basis 17 carbon atoms arranged in four rings and including the sterols and bile acids, adrenal and sex hormones, certain natural drugs such as digitalis compounds, and the precursors of certain vitamins

Stimulant—An agent, especially a chemical agent such as caffeine, that temporarily arouses or accelerates physiological or organic activity

Testosterone—A hormone that promotes the development and maintenance of male sex characteristics.